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Healthy Self-Insurance

Managing catastrophic medical claims.

By Cyril Tuohy

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When it comes to self-insured employers caring for employees after a catastrophic injury, it's the little things that matter, such as having someone from the company show up at the hospital to spend some time with the patient.

"These are simple little things, but (not doing them) can cost your company a lot of money," said Davida McCloskey, vice president of claims for Attenta, an Alabama-based third-party administrator.

That's because very often self-insured employers have closer ties with their employees than do Fortune 500 companies who insure directly with an insurance carrier.

A little courtesy, which never costs anything, can't hurt, particularly when large sums of money are in play.

A patient suffering from trauma requiring long-term residential placement and exhibiting "behavior issues," said Carleton S. Reynolds, vice president of workers' comp claims with Safety National Casualty Corp., can easily cost $200,000 or more a year. Traumatic injuries to the brain cost more than $2 million. "Multiply that over a lifetime, and you can see how quickly costs can escalate with these cases," he said.

"But the bottom line for me as a claims manager, employing the best available resources is the best way to control the cost both in financial and human terms," he also said.

Experts in the management of catastrophic claims say one of the better ways, perhaps the best way, for companies to deal with such claims is to report them as soon as possible.

"The most important issue is notification," said McCloskey. "If we are not told about it, we can't act on it."

Because notification requirements differ from one state to another, it's best to report early, using e-mail, where the claimants have a record of reporting the claim in writing.

"Until we know about the claims, we can't add value and help with the management and eventual outcome of the case," said Reynolds.

"Once we're told about a loss, we can play our role in mitigating that loss," said Reynolds.

The good news, if there is such a thing, about self-insured catastrophic claims is that there is very little so-called "malingering."

"I attribute this to the alignment between injured workers and the employer due to the severity of the injury," Reynolds added.

June 1, 2006

Copyright 2006© LRP Publications

 
 
 
 
 
 
 
 
 
 
 
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